This is a guest post by Joe Knight
First Aid For Cold Weather Injuries
After TSHTF, you may be in a situation where you may be living in the woods to avoid the chaos that is sure to strike after the rules that hold society together unravel. If the weather is warm and nice, that won’t be a problem for those who have psychologically prepared themselves for it. Chilly and rainy might make you miserable, but surviving such conditions is still not going to be a problem.
The real challenge is going to be not only surviving, but living, during the winter. If you’re in the southern climes, that shouldn’t be a problem; however, if you live in the northern part of the country, winter generally means cold and snow. You know you can’t stay sheltered in the snug little cabin you had built when things were “normal”; at some point, you’re going to have to get out in the weather for hunting, scouting or chasing-down potential or real enemies.
Being exposed to the weather is going to be a prime consideration. Stress, lack of proper nutrition or lack of preparation is going to make you a prime candidate for a cold weather injury, also known as a CWI. How you manage a CWI can mean life or death.
Obviously, avoiding a CWI is always the best idea, but what are you going to do if you, a loved one or a companion becomes a casualty of the cold weather? In a pre-SHTF world, one could always go to the hospital where you will have the best possible care and have a good chance of a positive outcome, but in a post-SHTF world, such luxuries aren’t going to be available, so it’s going to fall on shoulders of the person who has been appointed as your tribe’s health care provider.
In this article, I will describe the four types of CWIs and how they should be managed on a post-SHTF world where “health care” as we know it today no longer exists.
Chilblains occur when the cold weather causes the blood vessels to constrict, and the most common site for chilblains is the feet. A person with chilblains says he feels like he’s walking with stones in his boots. When you examine the person’s feet, they may feel cool to the touch and may have pale areas on the soles. Chilblains are more of a nuisance than a serious problem, but the person with chilblains isn’t going to be operating at maximum efficiency; this could be a problem if you’re hunting or fighting marauders. Not only that, but if chilblains aren’t treated appropriately, they can evolve into a more serious medical issue.
The treatment of chilblains is pretty simple. Have him remove his boots and socks, and gently wash his feet in warm (not hot) water. Wrap his feet in a warm towel and keep him off his feet for around 12 hours if possible. The circulation should start normalizing, and you can then continue your mission. If he still has pain after 24 hours, he should head back to the cabin and kept warm for about a week.
Immersion or Trench Foot
Though technically there’s a distinction between “immersion foot” and “trench foot”, for the sake of this article, they’ll be considered the same thing.
If one’s feet are constantly exposed to water, especially cold water, the skin get’s waterlogged and is prone to breaking down. The feet look rather repulsive – they’re wet, shriveled and are generally numb. Blisters usually develop, and these can break. When that happens, you are now dealing with open wounds at a part of the body which is receiving a poor blood supply. This is a prime area for an infection to develop, and the last thing anyone needs in a post-SHTF world is an infection.
Like chilblains, treating a person with immersion foot is pretty straightforward. Dry the skin carefully, trying not to break any blisters. DO NOT apply, butter, grease, lotions or any other weird stuff. Confine him to bed with his feet elevated and exposed to the air. If the blisters break, gently dab off the fluid and apply an antibiotic ointment to the open wound. He also needs to stay off his feet. If all goes well, he should heal-up in a week-or-so.
Hyperthermia occurs when a person’s core body temperature drops to a dangerous level. One of the most common causes of hypothermia is sitting around the campfire in the dead of winter and getting drunk and stupid.
Knowing someone is hypothermic is pretty easy; he gets what health professionals call the “umbles” – he fumbles, stumbles and grumbles and is basically not acting like his normal self; the blood reaching his brain is cold, so it doesn’t work the way it usually does. The shivering mechanism, which is the body’s attempt at generating heat, may shut down, his speech becomes slurred and he gets confused. As the body’s core temperature continues to drop, he’ll become sleepy, his heartbeat will slow, and then he just…dies. Assuming this may be someone you care about, you need to get into action quickly.
If near your cabin, get him inside and strip him down to his underwear. If he’s still coherent, he may just need a blanket and something warm to drink. But since this article is written assuming the worse-case scenario, drastic measures need to be taken. Place him on a blanket and strip him down to his underwear.
Then you and your buddy need to strip down to you underwear. Each of you needs to snuggle-up to your bud and keep yourselves covered with blankets. The purpose of all this isn’t because of some kinky sexual thing – what you’re doing is transferring your body heat to your buddy. When your buddy’s core body temperature starts to rise and he starts coming out of his lethargic state, be ready for some potential violence; people coming out of anesthesia or warming-up from hypothermia can get combative (the fact that he’s waking-up with his two half-naked buddies snuggled-up to him isn’t going to go over very well either).
Once he’s reasonably alert, give him something warm to drink (avoid caffeine). Once he’s fully awake and alert, you can then explain to him how grateful he should be that you and your other friend liked him enough to strip to your skivvies and wanted some snuggle time.
One other thing – no matter how good he feels, he needs to stay put for 24 hours and drink warm liquids. It is at this point many folks coming out of hypothermia are encouraged to get up and walk around. It is also at this point where many of these people drop dead because the heart can stop when cold blood reaches it. That’s the main reason to keep him resting for 24 hours; if you need to get back to your cabin, build a travois and haul his butt back on that.
What most people call ‘frostbite” – isn’t. Frostbite means something specific, and is divided into four degrees: First degree, second degree, third degree and fourth degree.
First degree frostbite (also called ‘frost nip”) involves the freezing of the top layer of skin without the formation of blisters. First degree frostbite is easy to treat – all one has to do is to warm their hands or feet, but never by the campfire or stove. The nerve endings are frozen, so the person can’t perceive heat very well, and can wind-up with a first or second degree burn without realizing it until it’s too late. If his hands are affected, have him place his hands in his armpits until the fingers are warm. If his feet are affected, you can play hero and let him place his feet in your armpits until the feeling returns to his feet.
Second degree frostbite involves the formation of blisters, which can be filled with clear fluid. The treatment of second degree frostbite is treated just as immersion foot mentioned above.
Third degree frostbite involves a bluish-gray discoloration to the skin (due to lack of good blood circulation), and the formation of blisters, usually filled with blood. In a post-SHTF world, there’s not much you’re going to be able to do for your friend except treat the hands or feet just as you would second degree frostbite. The problem you may have is some skin may die and slough off. The best you’re going to do in this type of this situation is treat the open wounds as you would any other injury and try to prevent infection. Another problem is that the affected toes or finders may shrivel-up, mummify, die and fall off. As disgusting as this may sound, this is the body’s way of getting rid of non-functional body parts. If the person survives this, he should be OK after a month-or-two.
Fourth degree frostbite is obviously the most serious type of CWI. In this case, the skin is frozen down to the bone. If you or your bud gets fourth degree frostbite, several things are going to need to be kept in mind: First of all, there’s a good change whoever is afflicted will probably not make it. It’s not the CWI that’ll kill him – it’s usually the infection that follows that’s usually fatal. To try to increase the odds of your friend surviving, the following precautions need to be taken:
First of all, if a limb is frozen solid and you still need to travel, do not allow the limb to thaw. Even if the person has to walk back to the cabin with a frozen leg, it’s better that way. If a limb freezes, thaws then is frozen again, tissue damage will be much greater. Also, if it thaws before you get back to your cabin, you’re going to have a horrendous mess on your hands as the tissue thaws – blisters that form will then break and leak, dead skin and muscle tissue will be sloughing off…you get the idea.
When you get your friend to the cabin, all those horrible things I just mentioned are going to happen. If your friend is “lucky”, the frozen limb or digit will just mummify and fall off, but it’s best to prepare for the worse. Dead tissue is a wonderful breeding ground for bacteria, which can then enter the bloodstream and start a generalized infection from which few survive.
The best way of treating a CWI is preventing it in the first place. Proper nutrition, proper clothing and common sense should help prevent the problem. You’ll have enough to worry about in a post-SHTF world. A CWI shouldn’t be one of them.
Bio: Joe Knight is a Physician Assistant and a medical writer in Chowchilla, California. During his 20-year military career, he was a Battalion Surgeon in the Arctic Infantry Brigade at Fort Wainwright, Alaska.